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Hi Everyone,
Here’s a “Laser Periodontal Therapy” case I started last week.
This photo series demostrates the key element in treating ALL types of periodontal disease case types in only ONE treatment visit. That is, as opposed to treating a pocket or quadrant in a series of sequential visits, one week apart.
They KEY is getting a stable fibrin clot to form immediately post-op, and before the patient is dismissed.
Profound anesthesia is ALWAYS used for intial treatment.
[img]https://www.laserdentistryforum.com/attachments/upload/MarkXray.JPG[/img]
Pre-Op X-ray. Can a pocket be a VERY thick PDL space?
[img]https://www.laserdentistryforum.com/attachments/upload/Markpoach1.JPG[/img]
4.00 watts, 20 Hz, 200 mj/p, 360 micron fiber, 650 usec PD @ 110 Joules per tooth
[img]https://www.laserdentistryforum.com/attachments/upload/Markpoach2B.JPG[/img]
Obtaining a predictable, controllable, reproducible and STABLE fibrin clot has been difficult for all laser devices (especially CW diodes with or w/o “activated” hot-glass effect), until we found the value of varying the pulse duration on a pulsed Nd:YAG. Extending the thermal “injury” time for just a few hundreds of microseconds made all the difference—not too cold, too short thermal exposure time, or too photo-disruptive, AND not too hot as to vaporize, cauterize, burn the blood proteins away (they are VERY thermally sensitive;-), OR sear or DRY out the tissue edges that would prevent “clotting closure” of the wound.
[img]https://www.laserdentistryforum.com/attachments/upload/Mark7day3.JPG[/img]
7 Day post-Op reveals fibrin clot persisting in the area still struggling to heal in the bicuspid region. The area that is healing the best, is the area which had the deepest pockets, most root surface areas involved and most negative tissue architecture. But it is important to note that the area still needing the fibrin coverage, is still showing the fibrin along with residual tissue redness and inflammation. So is that SLOW healing? Or something else???
Microscope shows higher magnification of the desirable fibrin and its appearance. No, it is NOT necrotic tissue. It also shows a better idea of how well the inner interproximal tissues are healed……sealed down below.
[img]https://www.laserdentistryforum.com/attachments/upload/Mark7dayHiResV4.JPG[/img]
Self explanatory
Self explanatory
[img]https://www.laserdentistryforum.com/attachments/upload/Mark7day5.JPG[/img]
OK…..really high magnification of the interproximal tissue appearance
Bob
QUOTEQuote: from Robert Gregg on 7:34 pm on June 5, 2003[img]https://www.laserdentistryforum.com/attachments/upload/MarkXray.JPG[/img]
Widened PDL= Occlusal Trauma?
??HI folks: I just wanted to show you what the combination of the laser and the microscope can do for treating children.
I did this whole case on a 5 year old today without anesthetic except for topical….took around 30 mins including photos.
Primary interproximal caries were moderate in size on the primary molars, and the Erbium Yag laser was used at 30 Hz and 160 mj with 600 micron 80 degree tip on Hoya Delight laser. That would be around 4.8 watts for the Biolase folks with a tip that has a 6 after it.(600 micron)
I prepped the first primary molar with an interguard in between to show you how to protect the adjacent tooth and the final photo (enlarged) shows how the decay is visible at 16X mag with the scope. You could see the hole and in addition see which side of the contact the prep needed to go.
The concern is how to check for the fact that all decay is removed as the laser is non tactile, and I either will use high magnification ( can see if the dentin is still leathery), sharp spoons (mark colonna makes a great set of these) or a slowspeed round bur near the end because there is a little bit of desensitization that occurs after using the laser for a couple of minutes that allows for etch and slowspeeds to be used judiciously.
I filled the base with a flowable (Dyract) and Tetric Ceram overtop.
The dad was watching and they are always stunned to see what is possible now ( they watch the magnified view from the microscope, on the monitor………can hardly wait for flatscreens to come down in price) and he was very appreciative of his daughter not needing anesthetic for these teeth.
I will go out and say that you can sometimes do these in kids with a bur, but it has been my experience that although the laser may be slightly slower the sensitivity with the non contact mode of operation, the water spray to cool the tooth and the gentle popping make this a nice alternative for children.
If you want to say …….I never have a problem numbing up children……..I can do that in 7 minutes…….kids are no problem for me, then that is fine, and I wont argue with you. I will say though that many of the children I have in
my practice are great when I use the laser on them……its nice having another tool in the toolbox.I am just here to show you a few pics ( like a coffee table book, just think of me as the Kramer of scopes and lasers then) so that those of you not using a laser might see what these preps look like.
Hope that you enjoy it……..all the best….
Glenn
